With the goal of reducing the number of inpatient and emergency department abdominal ultrasound exams in patients who had recently received an abdominal CT study, researchers from Johns Hopkins Hospital created a best-practice advisory (BPA) for abdominal ultrasound in the institution's electronic medical record (EMR) software. The BPA advised the review of CT results in adult patients who had undergone abdominal CT within the previous 72 hours.
After the BPA was sent out, 96 (16%) of 614 subsequent ultrasound orders were canceled for these patients. Chart reviews showed that care was not compromised in these patients. Furthermore, chart reviews of 100 patients who still received ultrasound scans demonstrated a lack of contributory findings in the evaluation of the kidneys, liver, and biliary tree, according to presenter Dr. Pamela Johnson. Various miscellaneous concerns also were better evaluated on CT, and at least 42 ultrasound scans for acute kidney injury or renal stones could potentially have been avoided, she noted.
Abdominal CT provides more diagnostic information than abdominal ultrasound in many cases, Johnson said.
"Inpatient and [emergency department] abdominal ultrasound may be obviated by a recently performed abdominal CT scan in many patients, particularly when ordering renal ultrasound in the setting of hospital-acquired AKI without risk factors for obstruction," she told AuntMinnie.com. "Implementing a smart BPA to avoid an unnecessary abdominal ultrasound in a patient with a recently performed abdominal CT safely reduces wasteful practice to decrease patients' total cost of care, but it is only effective in a small percentage of patients. Interventions need to be bolstered by education and provider feedback reports, which we will be adding in the next phase."
